Integration of classifications and terminologies in

metadata registries based on ISO/IEC 11179

Sylvie Ngouongo

Jürgen Stausberg

Ludwig-Maximilian-University of Munich, Germany

Institute of Medical Informatics, Biometry and Epidemiology (IBE)

These sheets are only for use in connection with the speech.

Presented by Sylvie Ngouongo

MIE 2011, Sylvie Ngouongo 2

Agenda

•  Introduction

•  Objectives

•  Material –  ISO/IEC 11179 V3

–  Classifications and Terminologies

•  Methods and Results –  Mapping

–  Import

•  Discussion

•  Conclusion

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Introduction

•  Empirical medical research –  is based on the collection of observations stored in DBMS;

–  needs services for the maintenance of item collections and improvement of semantic interoperability: •  Reuse of item`s definitions

•  Quality improvement through harmonization and standardization,

•  Integration and use of controlled vocabularies as value lists for items.

•  MDR-Project in Germany launched in 2009 by the Federal Ministry of Education and Research to set up a national Metadata repository for the support of empirical research. –  ISO/IEC 11179 V3

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Objectives

•  Appropriateness of ISO/IEC 11179 V3 “Information technology - Metadata Registries (MDR)” part 3 “Registry Metamodel and basic attributes” for a national MDR in Germany.

•  Possibilities of including well-established classifications and terminologies (controlled vocabularies) using the metamodel of ISO/IEC 11179 V3.

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Material: ISO/IEC 11179 V3 Data Description Package

•  ISO/IEC 11179 describes the method of standardizing and registering of data elements to make data understandable and sharable.

Data_Element_Concept Conceptual_Domain

Data_Element Value_Domain

Object_Class Characteristic

gender karyotype  <men|women>

gender  <male|female> <male|female>

person sex

1

1

1 1

*

*

*

*

*

0..1 0..1

representation layer

concept layer

*

Data Description Package with examples in grey

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Material: ISO/IEC 11179 V3 Concept Metamodel Region

Concept_System Metamodel Region

Classification Metamodel Region

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Material: Classifications and Terminologies

•  ICD-10-GM: International Statistical Classification of Diseases and Related Health Problems 10th Revision German Modifications

•  OPS: German procedure classification

•  The TNM classification of malignant tumors: a well-established standard for the classification of malignant tumors in oncology. the TNM-system classification provides three axes for post-coordination (T: local tumor, N: regional lymph nodes, M: metastasis).

•  MedDRA: Medical Dictionary for Regulatory Activities, the international medical terminology used to classify adverse events associated with the use of biopharmaceuticals and other medical products.

•  SNOMED-CT: Systematized Nomenclature of Medicine-Clinical Terms, a multilingual clinical healthcare terminology, essential for electronic health records.

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Material: Classifications and Terminologies - ClaML

•  Classification Markup Language (ClaML) is attractive as interface standard for the import of classifications (ICD-10-GM, OPS) into the MDR.

•  ClaML: EN 14463:2007, Standard for electronic representation of classification coding schemes.

<?xml version="1.0" encoding="utf-8"?> <!DOCTYPE ClaML SYSTEM "claml.dtd"[]> <ClaML version="2.0.0"> <Meta name="TopLevelSort" value="I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI XVII XVIII XIX XX XXI XXII" /> <Meta name="lang" value="en" /> <Meta name="titleLong" value="International Statistical Classification of Diseases and Related Health Problems 10th Revision"/> <Identifier authority="WHO" uid="SRFSFto be added later" /><?xml version="1.0" encoding="utf-8"?>

<!DOCTYPE ClaML SYSTEM "claml.dtd"[]> Title<ClaML version 2.0.0"> <Meta name="TopLevelSort="I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI XVII XVIII XIX XX XXI XXII <

Meta name="lang" value="en" /> <Meta B27.0 name="titleLong"

value="International Statistical Classification of Diseases and Related Health Problems 10th Revision"/> <Identifier authority="WHO" uid="SRFSFto be added later" =" />

<Title ="2008-05-13 name="ICD-10-2008-EN" version="2008" /> <

Class code="B27" kind="

category"> <Small excerpt of ClaML

ClaML and its structure´s elements

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Methods

•  Mapping –  Approach and results

•  Import –  Approach and results

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Mapping: the approach

•  Mapping of ClaML Elements to elements of ISO/IEC 11179 V3 Metamodel.

•  Mapping of vocabularies structures to elements of the ISO/IEC 11179 V3 metamodel.

ClAML

ICD-10, OPS

ISO 11179 V3 1a

2

1b

representation

Structure Mapping

Structure Mapping

1c

If 1b and 1a, then

1c is possible

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Mapping : the results

Concept_System Metamodel Region

Classification Metamodel Region

ClaML.root; ICD-10-GM; OPS; TNM; MedDRA; SNOMED-CT

(Vocabularies)

ClaML-Classes / Vocabularies-Classes

Hierarchy

specialization

generalization

ClaML-Classes / Vocabularies-Classes

Classification´s semantic

Intestinal infectious Diseases (A00-A09)

Cholera (A00)

is_a

Example of ICD-10

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Import: approach and results

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Discussion

•  Representation of classifications and terminologies as sources for value lists of items is quite simple in ISO/IEC 11179 V3, however… –  Terminologies (MedDRA, SNOMED-CT) could be easily represented

both in the Concept Metamodel Region and the Data Description Package of ISO/IEC 11179 V3,

–  Representation of Classifications (ICD-10, OPS, TNM) in the Data Description Package ist not satisfactory yet,

–  Classifications´rules (inclusions, exclusions…) and exceptions could not be properly mapped in the Concept Package yet.

•  Full coverage of the item semantic is not reached yet, Implementation on logic level of application needed.

•  Different interpretations and extensions of the ClaML-Standard: DIMDI (ICD-10-GM 2010) vs. WHO (ICD-10-CM 2008).

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Discussion

•  Example of discrepancies between WHO and DIMDI regarding ClaML

WHO applies <Modifier> (subclassifications´coding) for 4-digit ICD-Classes to their superclasses (3-digit classes) whereas DIMDI applies them to the corresponding 4-digit classes to build the 5-digit subclassifications. M01 (3-digit) à M01.0 (4-digit) à M01.00 (5-digit)

<Class code="M01" kind="category" usage="aster">

<SuperClass code="M00-M03" />

<SubClass code="M01.0" />

<SubClass code="M01.1"< code

=" M01" kind="category" usage ">

<SuperClass code=" />

<SubClass code="M01.0" /> <

SubClass code="M01.1" /> <SubClass code

="M01.2" /> <

ModifiedBy all="<Class code="M01.0" kind="category" usage="aster">

<SuperClass code="M01"/>

<ModifiedBy all="true" code="S13M00_5"/> <Rubric kind="preferred">

<Label xml:lang<Class code="M01.0" kind="

category"< usage="aster"> <SuperClass

code</ ="Class M01

<Class code="M01" kind="category" usage="aster">

<SuperClass code="M00-M03"/>

<SubClass code="M01.0"/>

<SubClass code="M01.1"/>

<SubClass code="M01.2"/>

<<Class code="M01

category" usage="aster"> SuperClass

code="M00-M03"/> <SubClass

code

<Class code="M01.0" kind="category" usage="aster">

<SuperClass code="M01" />

<Rubric id="D0010244" kind="preferred">

<Label xml:lang="en" xml:space="<Class code

="M01.0" kind="category" usage="

aster"> <

WHO DIMDI

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Conclusion

•  ISO/IEC 11179 V3 is powerful and contributes many useful ideas for the definition of a national MDR.

•  An extension of ISO/IEC 11179 V3 metamodel to meet the predefined needs of a national MDR might be necessary.

•  A unique interpretation of ClaML by Healthcare organizations (WHO, DIMDI, …) is essential to continue work on the ClaML import interface.

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Acknowledgements

The presented work is part of the project MDR - Metadata Repository funded by the German Federal Ministry of Education and Research (BMBF).

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Take Home Message •  Support of empirical medical research through Maintenance of item collections:

–  Reuse of item´s definitions, –  Reviews of item collections through harmonization and standardization, –  Integration and use of controlled vocabularies as value lists for items.

•  ISO 11179 is a method of standardizing and registering of data elements to make data understandable and sharable. It is powerful and contributes many useful ideas for the definition of a national MDR.

•  Representation of classifications and terminologies as sources for value lists of items is quite simple in ISO 11179 V3. Problems arise when trying to represent classification´s rules (inclusions, exclusions…).

•  An extension of ISO 11179 V3 metamodel to meet the predefined needs of a national MDR might be necessary.

•  A unique interpretation of the ClaML-Standard by healthcare organizations is required to implement a common ClaML import interface.

Thanks for your Attention!

ngouongo@ibe.med.uni-muenchen.de